Treatment of hepatitis C virus infection in dialysis patients.
Treatment of hepatitis C virus infection in dialysis patients.
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透析患者丙型肝炎病毒感染的治疗。
DOI：
10.1093/ndt/15.suppl_8.46
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
Stanislas Pol
中科院分区：
文献类型：
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作者：
Stanislas Pol
丙型肝炎病毒（HCV）感染的频率与未接受透析的患者相同，这些患者接受慢性治疗的终末期肾衰竭患者因输血而感染：轻度透析（以及在同种异体移植物接受者中），对于大多数患者观察到慢性肝炎的患病率，根据地理上低HCV病毒血症和低HCV相关死亡率地区，从10%到65%不等。患病率显著相关，但在10%的患者中观察到肝硬化。它是透析的持续时间和输血的数量的1.4%（5），与医院传播的证据（6，7）;从阴性血清转换的发生率（11）。HCV感染的透析患者阳性的结果下降到0.56%，然后下降到0%，当普遍等待肾移植时，预防措施明显更差，尽管比接受肾移植的患者平均输血次数和患者种植园比例高（12）。在肾移植受者中，透析器重复使用或监测器消毒后，每次治疗的初始结果没有变化（8）。美国和欧洲（13，14）表明，血液透析患者中存在和不存在抗HCV感染的患者生存率的相似移植物和流行病学、血清学和病毒学数据广泛存在HCV抗体，但最近的研究似乎在世界各地报道，但临床影响与这些发现相矛盾（15-18）。这些研究表明，即生存率和组织病理学影响尚未表明应向尚未评估的候选人给予抗病毒治疗。而在肾移植的一般人群中，由于约80%的HCV感染患者的免疫抑制剂要么为预防同种异体移植物排斥结果而波动方案，要么转氨酶值持续升高，HCV复制增加的生物化学（导致病理异常的患者通常不太常见，75%的患者病情恶化，25%的患者发生肾脏疾病，三分之一的透析患者和一半的肝硬化患者在移植后5年内）（19）。肾受体）（9）。因此，迄今为止，在肾移植的管理中，排除了进一步的抗终末期肾病和HCV感染的患者，病毒治疗，因为这种治疗与临床和生物学数据相关，特别是病毒学疗效率（~6%）和水平非常低的转氨酶，似乎没有什么诊断价值。由于一般人群的移植物排斥率高得令人无法接受（约45%），因此需要进行肝活检以进行精确检查（20，21）。评价肝病的分级和分期，特别是HCV感染与肾小球硬化的鉴别有明显的相关性。考虑到发生疾病的风险：临床表现为混合性乳糜泻-肝细胞癌、超声检查和甲胎贫血，透析患者每4个月需要检测一次膜增生性或膜性肾病蛋白水平。这些肝外并发症可能导致患者出现肝硬化，就像所有肝硬化患者一样（10）。自体肾（22）和移植肾（23）中的肾衰竭，导致所谓的新生肾小球-为什么要治疗透析患者的HCV感染？肾炎，这可能会导致肾功能不全
Hepatitis C virus (HCV ) infection is frequent in to be the same as that in patients not on dialysis who patients with end-stage renal failure treated by chronic have become infected as a result of transfusion: mild dialysis (and in allograft recipients), with a prevalence chronic hepatitis is observed for most patients, with a varying from 10% to 65% according to the geographical low HCV viraemia and a low HCV-related mortality area. The prevalence is significantly associated with but cirrhosis is observed in 10% of patients. It is the duration of dialysis and the number of transfused 1.4% (5), with evidence of nosocomial transmission (6,7); the incidence of seroconversion from negative to (11). The outcome of HCV-infected dialysis patients positive fell to 0.56% and then to 0% when universal awaiting renal transplantation is significantly worse precautions were reinforced, although the average than that of patients who had undergone renal trans- number of transfusions and proportion of patients plantation (12). with dialyser reuse or with monitors disinfected after In kidney allograft recipients, initial results from the each session did not change (8). USA and Europe (13,14) suggested similar graft and Epidemiological, serological and virological data on patient survivals in patients with and without anti- HCV infection in haemodialysis patients have been widely HCV antibodies, but more recent studies seem to reported throughout the world but the clinical impact, contradict these findings (15-18). These studies suggest i.e. survival, and the histopathological impact have not that antiviral therapies should be given to candidates yet been evaluated. While in the general population for renal transplantation, because immunosuppressive ~80% of HCV-infected patients have either fluctuating regimens for the prevention of allograft rejection result or constantly high aminotransferase values, biochemical in increased HCV replication ( leading to pathological abnormalities are usually less frequent in patients with deterioration in 75% of patients and a 25% incidence renal disorders (a third of dialysis patients and half of of cirrhosis, within 5 years after transplantation) (19). kidney recipients) (9). Thus, in the management of Renal transplantation precludes, to date, further anti- patients with end-stage renal disease and HCV infection, viral therapies because such therapies are associated clinical and biological data, specifically transaminase with a very low rate of virological efficacy (~6%) and levels, appear to be of little diagnostic value. As in the an unacceptably high rate of graft rejection (~45%) general population, liver biopsy is required for precise (20,21). evaluation of the grade and stage of liver disease, particu- HCV infection is clearly associated with glomerular larly for identifying cirrhosis. Given the risk of developing disease: clinical manifestations are mixed cryoglobuli- hepatocellular carcinoma, ultrasonography and a-feto- naemia, membranoproliferative or membranous neph- protein levels are warranted every 4 months in dialysis ritis. These extrahepatic complications may lead to patients with cirrhosis, as in all patients with cirrhosis (10). renal failure in native (22) as well as in transplanted kidneys (23), resulting in so-called de novo glomerulo- Why treat HCV infection in dialysis patients? nephritis, which may lead to non-functioning renal